Healthcare Reform in Nursing Homes Emerges as Key Ageing Policy Priority

As Europe's population ages rapidly, a new WHO-supported study warns that the future sustainability of health systems may increasingly depend on how effectively countries deliver healthcare inside nursing homes. The report identifies major gaps in primary care, specialist access and care coordination, while highlighting policy models that could reduce hospital admissions, improve quality of life and contain long-term healthcare costs.

Europe's nursing homes are becoming a critical frontline in the continent's response to demographic change, according to a new report by the European Observatory on Health Systems and Policies and the WHO Regional Office for Europe. The study, authored by Pauline Sarah Münchenberg, Dheepa Rajan and Bernd Rechel, examines healthcare provision in nursing homes across England, Germany, the Netherlands, Norway, Poland, Spain and Sweden and identifies policy options that could strengthen long-term care systems amid rising demand.

The findings come as Europe faces one of the world's fastest ageing populations. Increasing life expectancy and declining birth rates are driving demand for long-term care services, while nursing home residents are becoming increasingly medically complex. Most residents live with frailty, multimorbidity, cognitive impairment, dementia and polypharmacy, requiring continuous access to healthcare services rather than simply residential support.

Healthcare Delivery Models Remain Highly Fragmented

The report finds substantial variation in how countries organize and finance healthcare services for nursing home residents.

Ownership structures differ significantly. While approximately 92% of Dutch nursing homes are operated by non-profit providers, Germany's sector is split between 53% non-profit, 42% for-profit and 5% public providers. In contrast, most nursing homes in Norway, Poland and Sweden remain publicly owned, while England and Spain rely heavily on private-sector operators.

Financing arrangements are equally diverse. England stands out because around 41% of nursing home residents self-fund their care due to means-tested eligibility rules. Across Europe, public systems typically cover healthcare and care services, but residents often contribute toward accommodation and living costs.

For policymakers, these findings underline the absence of a single model for long-term care. However, the report suggests that governance, care integration and workforce deployment may matter more than ownership structure alone in determining outcomes.

Dutch Physician Model Emerges as a Potential Best Practice

One of the most significant findings concerns the Netherlands' use of dedicated Elderly Care Physicians (ECPs). Unlike most countries, where community-based general practitioners divide their time between nursing homes and private practices, Dutch nursing homes commonly employ ECPs directly.

A single full-time ECP typically serves around 100 residents and works alongside psychologists, physiotherapists, occupational therapists, speech therapists and nutritionists as part of a multidisciplinary team.

According to the report, this model has been associated with lower hospitalization rates, reduced demand for specialist services and higher satisfaction among nursing homes. ECPs provide proactive care, conduct comprehensive geriatric assessments and manage many conditions that would otherwise require specialist referrals.

For governments facing rising healthcare expenditures, the Dutch experience suggests that greater investment in on-site preventive care may reduce costly hospital admissions and emergency interventions over time.

Economic Implications: Prevention May Be Cheaper Than Hospital Care

The report highlights an important economic reality: nursing home healthcare is increasingly becoming a hospital avoidance strategy.

Where healthcare services are readily available within nursing homes, residents are less likely to require acute hospital admissions, which are often expensive and disruptive. The study notes that many acute conditions, including infections, palliative care needs and rehabilitation services, can be managed on-site when appropriate staffing and medical expertise are available.

This finding has major implications for public spending. Across Europe, healthcare systems are already grappling with workforce shortages, fiscal pressures and growing demand from ageing populations. Investment in primary care, rehabilitation services and multidisciplinary teams may therefore generate significant long-term savings by reducing dependence on hospital-based care.

For finance ministries and health planners, the report strengthens the case for shifting resources toward prevention, integrated care and community-based services rather than relying primarily on hospital expansion.

Development Partners Face a Growing Long-Term Care Agenda

The study also carries important lessons for international development institutions, including the World Bank, WHO, regional development banks and bilateral donors.

Historically, long-term care has received less policy attention than acute healthcare. However, the report suggests that ageing societies will require substantial investments in workforce development, healthcare infrastructure, digital care coordination systems and integrated service delivery models.

Development partners supporting health system strengthening can play a crucial role in helping countries design sustainable financing mechanisms, build geriatric care capacity and develop quality assurance frameworks for long-term care facilities.

The report also highlights the need for stronger data systems, as evidence on the effectiveness and cost-effectiveness of different nursing home care models remains limited.

Opportunities and Risks for Private Investors

The findings have growing relevance for private-sector stakeholders as demand for long-term care services expands.

The rapid growth of elderly populations is likely to increase demand for nursing homes, assisted-living facilities, telehealth solutions, rehabilitation services and specialized geriatric care. Private providers that invest in integrated care models, digital health tools and multidisciplinary staffing may be well-positioned to benefit from this demographic trend.

However, the report also highlights risks. Workforce shortages, rising operating costs and increasing regulatory scrutiny could affect profitability. Policymakers are likely to place greater emphasis on quality standards, transparency and accountability as nursing homes become more central to national healthcare systems.

For investors and operators, future competitiveness may depend less on expanding bed capacity and more on demonstrating measurable improvements in health outcomes and care quality.

Policy Priorities for the Decade Ahead

The report concludes that Europe's ageing challenge is fundamentally both a healthcare and development challenge. It recommends stronger primary care systems, improved coordination between hospitals and nursing homes, wider use of multidisciplinary teams, comprehensive geriatric assessments and better integration of allied health professionals.

For governments, the message is clear: investing in healthcare delivery within nursing homes is no longer a social care issue alone. It is increasingly a strategic policy tool for managing healthcare costs, improving population health and building resilient health systems capable of supporting rapidly ageing societies.

As Europe enters an era of unprecedented demographic change, the countries that successfully integrate healthcare and long-term care may be best positioned to protect both public finances and the well-being of millions of older citizens.